The Preventable Shunt Revision Rate: A Multicenter Evaluation

Research output: Contribution to journalComment/debatepeer-review

8 Scopus citations


BACKGROUND: The Preventable Shunt Revision Rate (PSRR) was recently introduced as a novel quality metric.

OBJECTIVE: To evaluate the PSRR across multiple centers and determine associated variables.

METHODS: Nine participating centers in North America provided at least 2 years of consecutive shunt operations. Index surgery was defined as new shunt implantation, or revision of an existing shunt. For any index surgery that resulted in a reoperation within 90-days, index surgery information (demographic, clinical, and procedural) was collected and a decision made whether the failure was potentially preventable. The 90-day shunt failure rate and PSRR were calculated per institution and combined. Bivariate analyses were performed to evaluate individual effects of each independent variable on preventable shunt failure followed by a final multivariable model using a backward model selection approach.

RESULTS: A total of 5092 shunt operations were performed; 861 failed within 90 days of index operation, resulting in a 16.9% combined 90-day shunt failure rate and 17.6% median failure rate (range, 8.7%-26.9%). Of the failures, 307 were potentially preventable (overall and median 90-day PSRR, 35.7% and 33.9%, respectively; range, 16.1%-55.4%). The most common etiologies of avoidable failure were infection (n = 134, 44%) and proximal catheter malposition (n = 83, 27%). Independent predictors of preventable failure (P < .05) were lack of endoscopy (odds ratio [OR] = 2.26), recent shunt infection (OR = 3.65), shunt type (OR = 2.06) and center.

CONCLUSION: PSRR is variable across institutions, but can be 50% or higher. While the PSRR may never reach zero, this study demonstrates that overall about a third of early failures are potentially preventable.

Original languageEnglish (US)
Pages (from-to)797-798
Number of pages2
JournalClinical Neurosurgery
Issue number3
StatePublished - Mar 1 2019


  • Cerebrospinal Fluid Shunts/adverse effects
  • Child
  • Child, Preschool
  • Equipment Failure/statistics & numerical data
  • Female
  • Humans
  • Hydrocephalus/surgery
  • Infant
  • North America
  • Odds Ratio
  • Reoperation/statistics & numerical data
  • Retrospective Studies
  • Risk Factors

PubMed: MeSH publication types

  • Multicenter Study
  • Journal Article


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